Mrs. Anthonette Patterson BartleyLecturer, MScN Ed, RM, RMN, RNMay 18-July 20, 2015

At the end of the unit students will be able to:

1. Discuss the historical and current perspectives of maternity nursing in Jamaica; 2. Discuss contemporary trends and issues of maternal and child health; 3. Relate the social issues impacting on maternal and child health nursing.

4. Define terms used in reference to vital statistics relative to maternal and child health. 5. Briefly discuss the process in registering births and deaths in Jamaica.

6. Discuss legal and ethical issues of maternal and child health in Jamaica.

Midwifery is not a new concept. It existed even in Biblical Times. Exodus 1 vs. 15 21During slavery, plantation owners had little interest in the health of slaves until the slave trade was abolished in 1807.Owners actively engage doctors from England, who took special interest in maternal and newborn care.

The collapse of the estate health system led plantation owners to petition the government.

In 1875, the Island Medical Services was formally established, with a superintendent to supervise district medical officers (DMOs) across 41 medical districts.

In 1887, Dr Grabham- first champion of women's health, succeeded in establishing a 12-bed Lying-In Hospital on property adjacent to Kingston Public Hospital.

The hospital's main intent was to train midwives and its first graduates emerged two years later.

October 2007, maternal health advocates marked the 20thanniversary of the birth of the Safe Motherhood movement.

N.B. The 1st midwifery school was set up in England in 1875.

Practice of Nanaspre-emancipation period 1807 efforts were made to provide better medical facilities, as it was important for the slaves to remain as healthy as possible. Every estate had its hospital or Yaw hut and its Grandy an old woman who took care of the pregnant female before, during and after confinement.

About fourteen (14) days before delivery they were sent to a woman A Nana who kept an establishment as a midwife.

In what year did Dr Grabbam established the victoria Jubilee hospital?1807170818771887

1891 hospital was handed over for occupancy by the Public Works Department. Capacity was for 12 patients, 14 pupil midwives and a resident Matron.

1947 capacity was 110 beds, a daily average of 140 patients and 5,150 deliveries for the year.

The demands for beds increased and in 1955 preparation were made to start a new maternity block. In October 1958 a new building of four (4) stories high consisting of:

The bed capacity V.J.H. now 230 beds and 104 cots with over 9000 deliveries per The hospital has a cadre for 35 level 1 midwives and 10 level 3 midwives supervisors.

The training of Midwives was carried our primarily at Victoria Jubilee Hospital

The midwifery Law of 1919 made graduates legally accepted as Registered Midwife. In 1932 a syllabus for training was formulated.

There are three (4) well-established schools of Midwifery now functioning.

V.J.H Kingston School of Nursing Midwifery Cornwall School of MidwiferyUniversity HospitalSpanish town Hospital

Pre natalPost natalAntenatalDeliveryHeath education and promotion

Discuss contemporary trends and issues of maternal and child health;

TrendImplicationFamilies are not as extended as in previous generations.Nurses are therefore called upon to fulfill this role more than everThe number of single parent families increasing rapidly it now equals the number of nuclear familiesA single parent may have fewer financial resources than dual employed parents. Hence nurses need to be more aware of alternative care options and available to provide a backup opinion as needed.

Child and intimate partner violence s increasing in incidenceNurses must be aware of the legal responsibilities for reporting violence

Contemporary childbirth is family centerredHusbands, children. Lesbian partners all wants to play a part .

TrainingUse of TechnologyCostsLegal and ethical considerationRegistration Policies

Relate the social issues impacting on maternal and child health nursing

PovertyRe-emergence of poor nutritionLack of education maternal educationTeenage pregnancy- even though there is a decrease from 25% -20 there is a social connection to teenage pregnancyCulture mule if you are not pregnant by a certain age. And if you are too old and is pregnant- high rates of abortion.

Don man leadership styles.Poor family structureStressViolence- In a study published in 2012 showed that homicide rates affected both maternal and child health in so much that in Jamaica homicide rate was 53/100,000 followed by Belize 42/100.000Socio-economic status

Define terms used in reference to vital statistics relative to maternal and child health

Crude Birth Rate Fertility RateFoetal Death rate Neonatal Mortality RatePerinatal Mortality rateMaternal Mortality RateInfant Mortality RatePost-natal mortality rate

Briefly discuss the process in registering births and deaths in Jamaica

Registration is the recording of a vital event by a Local District Registrar (LDR). This record is then transferred to the Registrar General's Department's vaults within six weeks.Births: Registration of births is the responsibility of the child's parents if the child was born outside of a hospital or the Chief Resident Officer if the birth occurred in a hospital or a birthing center.

The parent(s) should ensure that the name of the child is decided upon by the time he/ she is due to be delivered.

The registration of the birth of the child must not be delayed. The Local District Registrar (LDR) office nearest to the place of birth must be attended as soon as possible in order to complete birth registration.

All birth registrations taking place over three months require an informant to attend the LDR office and sign the form.

All registrations taking place after one year of occurrence are considered Late Registrations, and require authorization from the Registrar General.

BEDSIDE REGISTRATIONThe Registrar General's Department conducts registration of births and still births at the bedside of the mother while in hospital. Vital information, including but not limited to, date of birth of child, sex of child, mothers name and doctor or midwife present at time of birth are captured.

All births must be registered:

Within 3 months and less than one year

Within 14 days Chief Resident Officer must send the notification of birth to LDR

If the infant is not named in the hospital- Visit the LDR for the district where the child was born and complete a Certificate of Naming;Give full and correct informationCheck for correct spelling of nameCheck date of birthSign registration form only if all the information is correctCollect Certificate of Registry (pink paper/slip)Keep a record of the Birth Entry Number for reference

With respect to registration, it is necessary to classify deaths as natural, sudden or violent. Natural deaths are those where the deceased was being attended to regularly

by a medical doctor (within at least three months of death) and where the cause of death is not under reasonable doubt by the medical doctor.

All deaths require either one of the following to be completed and certified by a medical doctor, medical officer or pathologist:

Medical Certificate of the Cause of Death

Post Mortem Examination Report

Certificate of Coroner (Form D)

Coroners Certificate of Finding of Jury (Form E)

Discuss legal and ethical issues of maternal and child health in Jamaica.

Although ethical dilemmas confront nurses in all areas of practice, those related to pregnancy, birth, newborns and children seem especially different and sometimes difficult to resolve.

Technology: makes it possible to sustain the lives of children who would have died thus creating many ethical issues. Conflict often arises between health professionals and parents when parents choose to withhold therapy or to request aggressive therapy on behalf of their child/children and the health professionals have a different opinion about treatment.

Family planning usage: 16 years age of consent for sexual encounter, 18 years age for consent to health care.

Culture

Laws governing certain procedures eg. tubal ligation

Access to care- abolition of user fees since 2007 for child health and 2008 for maternity nursing.

Organ transplantation issues- death of a child can benefit another child through organ transplantation. The limited supply of organs has created numerous ethical issues.

Please research the following definitions relating to maternal and child health nursing statistics. Crude Birth RateFertility RateFoetal Death rate Neonatal Mortality RatePerinatal Mortality rateMaternal Mortality RateInfant Mortality RatePost-natal mortality rate